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Applying to Radiology

Applying for residency is anxiogenic. That’s true for essentially anyone and everyone but perhaps even more so when applying to competitive fields, advanced specialties requiring a preliminary year, or field/location combinations you are not necessarily competitive for. The bright side is that it’s a temporary problem, and in a few extra months you’ll probably have a job and a very expensive piece of paper that says you’re qualified for it. Like other (sometimes more expensive) alternative sources, I have compiled some sage and mostly common sense advice for how to approach (and succeed in) the match.

Below are some additional thoughts to aid those who are considering pursuing a career in diagnostic radiology. Most of what follows will apply to other fields as well.

Academic “competitiveness” and your USMLE Step 1 score

There is a misconception amongst medical students that the average step score for a given field implies a necessary threshold to obtain a residency in that field. This is wrong. The average score is just that—an average. Where you want to do your residency, the prestige/quality of the program, etc. has just as much if not more to do with whatever “gold star” requirements you might need as the actual field itself. As I’ve discussed elsewhere, the key in applying to a competitive field has a lot to do with finding an appropriate mix and number of programs to apply to for your level of competitiveness. Even people who seem/are “great” may not be competitive at a given program due to idiosyncratic factors, its program director’s preferences, and geographic bias. The bottom line is that if your passion lies in a field with an average Step 1 far above your score, then you need to be willing to apply to community programs, apply to less “desirable” cities, try to woo your home institution, and generate a back-up plan. If you lost the thick skin you earned from applying to med school, it’s probably about time to get it back. No one gets all the interviews they apply for.

In 2011, the mean matched applicant Step 1 score for diagnostic radiology was 240, which is almost as high as it gets (topped only by dermatology, ENT, and integrated plastic surgery). However, the unmatched average was 211. The 30 point difference between matched and non-matched applicants tells you that there’s a lot of room in the middle for people who are below the average.

It is true however that many of the more competitive programs utilize automatic minimum cutoffs, often as high as 240. There are certainly plenty of people with 250+ and AOA applying to radiology, and some programs do have a preponderance of these folks. US allopathic applicants with scores of 250+ and concordant grades/AOA can expect to get interviews at a portion of the most competitive programs regardless of what medical school they attend. (NB: If the radiology program director at your institution feels differently or the track record at your school is different, they’re probably right and I am wrong.)

If you are a US allopathic grad and your score is ~220 or higher, there is almost certainly a job in radiology for you if you’re flexible and apply thoughtfully. The mean number of programs ranked was 13.3 for successful applicants and 3.4 for unmatched applicants. So the take-home message: go on enough interviews that you are statistically unlikely to go unmatched. 12 has been considered the magic number, but a qualified applicant with a good mix of programs (not all ‘reaches’) almost certainly doesn’t need this degree of safety. In 2011, 81% of applicants match at one of their top three choices. As a general match rule, having the “average” Step 1 score for a field or higher actually makes you pretty competitive.

There’s a lot of ego involved in discussing the various “tiers” of programs. Rest assured that outside of ego-stroking, there is plenty of good training to be had. Of note, training quality and prestige are not equivalent. Competitiveness and rankings are multi-factorial beasts that often involve things that are irrelevant to you as an applicant. Some fantastic programs are less competitive based on location. Some less stellar programs are extremely competitive based on location alone. The only reason tiers truly matter is to make sure you apply and interview at a reasonable mix. Interviewing at only nationally-recognized powerhouses and no great regional academic programs is not a fantastic idea. The fanciest programs may require some serious portfolio magic, but radiology is actually a pretty large field with a lot of spots.

Away Rotations

…are unnecessary in radiology. The most popular time to do an away rotation is in the early fall, which is coincidentally the best time to do sub-internships, get letters of recommendation, and take Step 2—all more important tasks.

If you do one, it’s because you want to, not because you need to. If so, be on time and don’t be irritating. Many students who do audition rotations are attempting to endear themselves to specific programs or break out of regional biases. There has never been any data on if this helps. Obviously, the majority of programs are interviewing and hiring people who do not audition there. Additionally, if you sound fantastic on paper, there’s always a significant chance that the real thing fails to live up to the hype. (Or vice versa, sure sure).

There is probably no other field in medicine where a medical student is as useless and incapable of shining as in radiology.

Letters of Recommendation

I recommend one letter from radiology—probably from the PD at your institution saying how much (s)he loves you and wishes you would stay—and no more. Medical students generally do not have significant clinical performance in radiology. Clinical rotations, specifically medicine and surgery, provide more meaningful letters. As for research letters, if you can tie together radiology and research together, great. Otherwise, unless your research is superlative or you were a rock star in the lab, a random letter from a random PI isn’t as meaningful as letters from clinical faculty. Many programs specifically request clinical letters for this reason, although occasionally a research letter can be included as a fourth (optional) letter.

Since you are applying to preliminary and transitional programs, it likely betters your chances to have three meaningful non-radiology letters when applying to these programs. Some internal medicine prelims will request a chair’s letter from medicine. So, most applicants should aim to net four LOR total: send the radiology letter and two best clinical letters to all radiology programs; send non-radiology letters to preliminary years.

Timing

Your application should be submitted on day 1, end stop. Many programs, particularly on the coasts, tend to interview late, so don’t panic when you don’t have interviews instantaneously when your peers applying to pediatrics and internal medicine do. You are likely to receive a preliminary medicine interview substantially before you’ll hear back from the radiology program at the same institution if you apply to both, which can make scheduling frustrating/irritating and expensive. You can browse forums at Aunt Minnie or SDN as gunners post their successes to find out if your favorite programs have begun sending out interviews, but this will probably make you absolutely miserable.

Don’t forget about intern year

The majority of Diagnostic Radiology programs are advanced (start PGY2). While there are categorical programs (those that include your internship), be very wary about the composition of the intern year. An advanced program leaves you the opportunity to hunt out and find a delightful (by comparison) intern year, either in the same location as your categorical program or another one if you want to try out a different city for a year. There are good categorical programs with good internships, but historically many of these internships are painful. If you ask current residents about their feelings about PGY1, they will tell you to find the easiest program possible. I have a hard time imagining any internship that would not give you an idea of what’s it like to be a clinician and the clinical basis you need to place radiological findings into clinical context. There is a competing theory held by a minority of persons that those who are interested in interventional radiology should pursue a surgical internship to help them learn the management of surgical patients. Most would argue that that is an unnecessary and painful mistake and leave it at that.

Typically the most desirable internships are Transitional Year programs, though the relative desirability is highly variable. You simply have to ask around to find out which ones are “good” or “cush” or not. Be warned that the best TY programs are often more competitive than the advanced specialties themselves. The bulk of TY interns are entering dermatology, radiology, and ophthalmology, three of the most competitive fields in medicine. Don’t neglect your internship.

How important is research?

You’re probably wondering if your lack of research will preclude your success in the match. While research can “make” your application, its absence is unlikely to break it. Except at a handful specific high-powered research-centric programs, research isn’t a prerequisite for all program directors. Even some “top” programs have gone as far to say things like, “We don’t care if you do research or not. We care about you being a leader in the field,” and other statements of the sort. That said, research never hurts. And in some (rare) programs it is an absolute requirement. The stratification goes something like this:

research with publications >> “real” research with posters or nothing > a case report done the summer of fourth year when you realize you don’t have any research and panic ≥ nothing.

So not having research in radiology or an MD/PhD will not prevent you from getting an interview/job in the broad sense. If you happen to have a long-standing interest in radiology, by all means do some radiology research. Clinical diagnostic radiology research is generally flexible and approachable time-wise as a medical student. Ask the program director or medical student coordinator at your home institution if they know anyone who needs help with a project (especially a poster, which would probably net you a free trip for literally formatting together a single big Powerpoint slide). Research in other fields counts just fine, of course. Programs know that many students may not have been exposed to radiology early enough to do radiology research. Note that if you mention research in your application, you will be discussing it come interview day.

This bit of advice doesn’t translate quite as well into certain surgical fields and dermatology, by the way, which do tend to be a bit more fanatical when it comes to paying your research dues.

The bottom line

Generalizations are dangerous and opinions should not be construed as prescriptive, but reasonable advice can be difficult to find, especially from the internet. Some other resources for applying to radiology, which are a bit intimidating, include the very thorough AMSER guide and this discussion from UT Houston. Again, a relatively inclusive collection of my all-encompassing thoughts on fourth year can be found here.

64 Comments

Thanks for this helpful post, Ben! Could I ask you please, I’ve heard radiology is a very tough match for IMGs (even with American citizenship) – would most of what you write here likewise apply to ‘US IMGs’ from a Commonwealth nation (e.g. UK, Australia in my case, New Zealand)? Would you have any additional advice? Cheers, Ben! :)

Complete conjecture is that programs would look more favorably on English-speaking programs in analogous countries than from Caribbean schools and especially from countries where healthcare is significantly different or training was conducted in another language. For what it’s worth, I made that up. What I can say is that, anecdotally, IMGs I’ve met working in radiology seemed to have greater research experience than their US counterparts, and that even some top tier programs seem willing to take the “right” international students. I have met plenty of internationally trained residents in a variety of fields, although more frequently at regional academic and community programs (which isn’t a bad thing imho). And most of course haven’t come from Commonwealth nations, which do not have many of the perceived limitations of international training.

The most important thing it seems to me applies for all non-“traditional” competitive applicants (IMG, DO, low board scores, blemished record, not graduating this application cycle, etc): apply broadly and utilize the relationships you (and your program/school) have.

The radiology job market has been tighter the past few years than it was in the early 2000s. The causes are multifactorial, but the bottom line is that the radiology market, like most markets, has historically had its own boom and bust cycles. It seems like we’ve probably reached the nadir, and recent reports are that the market is starting to open back up again. Residents at my program have continued to do well in finding jobs throughout, though many of available jobs are more demanding than most people associate with the field; this is partially due to the changing nature of private practice–the pressure to interpret more studies, hospital contract competition, and group consolidation–but mostly this reflects the fact that most non-radiologists have little idea what it feels like to practice radiology day in and day out (it’s a field that is especially difficult to understand from a medical student perspective).

By the time any medical student finishes their future training in radiology, the market is likely to be quite different. The essential point is it’s a terrible idea to enter a field based on the current pay prospects or the job market, as all of these things ebb and flow with time. You spend too many hours working in any field to do something you don’t like.

Wish I had found your site earlier. Today was not a good day…got a relatively humbling 229 on Step 1 (avg 230+-20). I’m really interested in radiology and had high hopes of matching at a university program.

How screwed am I? Will I be able to compensate with great MS3 grades and Step 2? I read this post but was hoping for more insight.

Not screwed. Radiology is a big residency speciality with a lot of university spots, and the fact that it’s recently become a bit less competitive overall won’t hurt you either. Just do the best you can going forward and applying broadly. While some of the bigger more flagship programs employ cutoffs, there are many programs that do not. Anecdotally, I know several people with scores 220-230 at university programs. I even know of one who failed Step 1 (though they were a special case).

hi. i have been reading your site and have found it very useful. thank you. i am applying into radiology. could you help with the following pointers – does it matter if i take step 2 at the end of august vs. end of september if i wasn’t happy with my step 1 score? what are middle level university programs for radiology? what does it take to get through a radiology residency? how many transitional year programs should i apply to? thanks!

Timing of Step 2 depends mostly on when PDs read applications. Now that Dean’s letters come out two weeks after ERAS opens, most now probably wait until the application files are complete. In the past, many PDs reviewed applications immediately and didn’t wait for the MSPE. So either August or September should be fine; I’d personally go for August if you can swing it for that margin of safety.

I’d rather not get into specific program rankings as such; contrary to the heated posting by medical students in forums, they are largely meaningless. In general, for competitiveness, consider those of middle competitiveness to include flagship state programs in “less desirable” states and non-flagship programs in more desirable states (e.g. Texas, but not California). In general, you will have better luck in the region that your medical school is located in.

What it takes to get through is an interesting question. The shortest and maybe best answer I can give you is a total of five years of residency to be followed by a 1-2 year fellowship and a few months of full-force board review in your PGY4 year. Radiology is I think significantly more mentally taxing than many fields but is certainly not unique in requiring a broad swath of knowledge. The hours generally being on a reasonable side partially make up for that. If a program is more call-heavy, it can be quite busy (typically PGY3 & PGY4 years). Otherwise, I believe it’s all and all a good, measured field during residency despite the learning curve.

How many TY programs depends partially on how important getting a TY is and what geographic factors are at play for you. If you have a guaranteed prelim spot at your home program, then your number of applications for comfort can be less. Since you pay for the first ten applications of each program type as a bundle, I’d apply to no less than 10. If there are preliminary medicine programs you are applying as well, those count separately, so the first ten of those are also a flat fee. Some people like the idea of living in a new place for a year. Others would rather try to do a TY near the places they hope to match for their advanced field. The NRMP program allows granular choosing when it comes to matching up your preferences, so you can set up your intern year differently for each potential advanced position.

I’m curious about 3rd year grades in the radiology match with the each tier of competitiveness within the field. I have a well above average step 1 score for radiology but 3rd year grades at my school are pretty random and subjective. I have gotten great evals and secured a LOR early in my third year and even am getting decent grades on NBME shelf exams but my final grades are not reflecting that. Different schools have different systems so how do they assess this? Class rank? At our school, only 3rd year determines class rank so I’m worried. I didn’t see anyone ask about 3rd year grades so any advice would be appreciated.

I really believe the main reason why USMLE scores became important is the difficulty PDs have in trying to compare students from different institutions. Schools DO determine grades differently and have different systems, so it can be apples and oranges. Some schools place a big emphasis on NBME exams, others predominately use subjective evaluations. Some are strict pass/fail, others are honors/high pass/pass, honors/pass, fully graded with pluses and minuses, etc. Some schools cap honors at some small percentage; others do not. Often, the grading schema is elaborated in the MSPE, but not everyone is going to pour over the Dean’s letter to find out.

Obviously when both Step 1 and grades are high, that’s easy to evaluate. When they’re both low, ditto. When there’s a discordance is where individual PD variance comes into play. High step and pretty good grades isn’t hard to figure out, and you’ll still easily find a good job. Trying to make sure your dean’s letter doesn’t include any red flag subjective comments is worth doing. When someone has a great Step but terrible third year grades, that usually indicates some level of a personality mismatch with multiple people or inability to function clinically and is a red flag.

Having not great grades in absence of amazing research would likely lock you out of the uber tier. Other than that you’d still have a shot elsewhere, with the understanding that some PDs have different personal biases. Making your application shine in other ways will help round out the picture.

I guess I’m confused what you mean by “pretty good grades” and “terrible third year grades”. How about being about 50th percentile (average) for every clerkship? Is that still considered “terrible” and a “red flag”?

Terrible means conditionally passing, repeating clerkships, or passing but with negative subjective comments. Red flags are usually damning subjective comments or failing. Getting completely average grades isn’t terrible, it’s average. There are definitely jobs out there for people with great boards and average grades.

Hi Ben, I’m a Caribbean IMG interested in radiology, my step scores are 240 and 240, I have all honors on all core rotations. My main question is if I apply broadly will I match? Also if I match into a program that doesn’t offer a preliminary year, how hard would it be able to obtain a preliminary year. I’m basically concerned I will match one without the other either preliminary without the specialty or the specialty without the prelim, the former more likely. Do I have a correct understanding of how it could go down?

Sounds like a pretty good chance of matching to me if you apply broadly. Your school should have some data on recent graduates that would be most helpful. The rad cycle has gotten easier the past couple years, which will work in your favor.

There are comparatively few categorical radiology programs, so you will probably need to match both separately. That being said, there are lot of preliminary spots available overall. Matching into a desireable TY is probably unlikely, and matching into a geographically convenient prelim medicine may also be challenging (this depends). But even if you have to SOAP to find an internship, if you match radiology and have that PGY2 job, I don’t think you’re likely to have much a problem getting an internship somewhere.

The way the match is set up, the prelim-years are a subordinate rank list to your advanced rank list (each radiology program can have its own prelim rank list). Thus, you don’t ever have to match prelim and not radiology, unless you put a prelim as an option at the bottom of your primarily ROL. That’s up to you, depends on what kind of backup plan you want to have in that event. If you do, then you can try to lock up an internship and then match just the rads in the SOAP instead of both (but you wouldn’t do this if you wanted to do internal medicine as a backup, for example).

Thanks for the quick detailed response. I forgot to mention I’m a us citizen incase that improves odds further. I have 6 months of electives left as well.

Should I be applying to preliminaries as soon as the application submittal opens up or should I wait to see if I get any interviews for radiology first? Also if I apply to say 100 rad programs should I apply to 100 prelims as well more or less? Is 100 broad enough, and do you have any info on what are the top programs IMGs have been matching into? I know it’s a lot of questions I’m just trying to cover all bases before I apply if you can do your best to answer I greatly appreciate any sorta response.

I asked my school where students have matched and they only let me know of one student who matched rads recently.

Thanks again for answering my original question that was very helpful.

Definitely apply to prelims at the same time. Many interview earlier in the season than rads programs, so it’s not a good idea to wait. 100 seems excessive; if you’re flexible most people don’t apply to as many internships as advanced program (but inflexibility or strong desire to have a cush year can inflate numbers quickly). Overall I don’t have any specific number ideas nor any information about IMG-friendly programs, but I’d recommend trying SDN or (especially) the Aunt Minnie forum.

Very interesting question and answer. My scores is nearly the same, but i am non-US IMG. I’d like to ask what “broadly” means. I want to apply in 4 states (NY, NJ, PA, CT) in about 35-40 programs. Is it broad enough?

Thank you in advance. (also, Ben, you blog is absolutely great, i have followed it for 2 years)

I’d try to apply to more than that if you can find compatible choices for yourself. However, the raw number itself can be misleading and isn’t really the point: broadly has just as much to do with programs of varying competitiveness as it does with absolute number. An applicant with a 220 on Step 1 from NJ could add Stanford, Mayo, Northwestern, UTSW, or a ton of other programs and those wouldn’t increase their chances of actually matching (i.e. those reach programs are the wrong programs to be relying on).

A program tends to interview somewhere on the order of around 10 people for every spot. It’s for that reason that slightly more than that (12-13) is considered a very safe rank list. Trying to pull at least 10 interviews from 40 programs for most non-US IMG (depending on the strength of the applicant of course) is probably a stretch. In your case, I’m not even sure there are 40 programs in those four states alone?

Sadly, it’s much safer to overapply and whittle down the interview list later than it is to apply reasonably and try to compensate later in the season if the interviews don’t come in.

Ben, thank you for taking the time to be so helpful to us hopeful applicants! I have a question of a different kind that Im surprised you haven’t written a piece on. That is “the grind.” Im applying rads this cycle and the one thing that worries me most about the field is falling victim to an endless torrent of mind-numbing studies needing to be read in higher and higher volume for less and less pay. Don’t get me wrong, there is certainly a grind to the direct patient care specialties but I think back to MS1/2 years and remember how exhausting it was to study all the time often in isolation. Many things become mundane overtime, would rads still be a good gig the day it starts feeling like a grind? Does balancing reading time with procedures help? Is the material able to be mastered or do you always feel barely above water? Do you leave work exhausted or feel good enough to go to the gym, cook and hang out with family/friends? When your home are you truly home or often thinking about what you need to be studying?

All excellent questions, and you’re right, it deserves a post (I’ve added it to the to-write list). The short answer is that (to me) radiology is more mentally than physically tiring, the grind as such as a resident is manageable though in private practice sometimes is not, the pros/cons of procedures and patient care vary by person (and even over time for the same person), timewise during residency radiology is more conducive to an outside life than the majority of alternatives, and the need/desire to study while generally true/commendable is overstated. There are definitely real plusses and minuses to radiology. Some of these are true for all fields while others are more unique (and often represent tradeoffs).

I can tell you I was originally an IR-type person who ended up choosing diagnostics, so it’s possible to seek out and find a personal balance within the field, just as there are different feels for different medicine subspecialities. The semi-objective reality is that career happiness is 75% personal, 25% job-specific (I made those numbers up).

Thought I’d reach out to you with my stats and see what my chances are for rads. PGY3 switching out of anesthesia, trying to get to rads. My PD and program are very supportive of the decision. US Citizen, US Med school grad from a good/known east coast medical school. I matched anesthesia at a big university hospital, Step 1: 195, Step 2: 222. I wanted to get an idea of where I should be applying and where to focus my ERAS. I’m not limiting myself to geography.

Since you’ve already completed your intern year, applying through ERAS will give you an additional gap year. I’d also try to find if any places have open slots for the coming year outside the match, as this may be easier overall. It’s not uncommon for a few spots to open up. I’d check out (and consider posting on) the AuntMinnie forum to see if there are any spot listings.

Within the match, the current applicant climate is in your favor overall, though most big university programs may filter you out by Step 1. I’d apply broadly but make sure to follow up with programs via email to hopefully get your application looked at. By scores alone you’re probably better off making sure to include nonflagship academic and community programs, but you’re not a traditional applicant, so you other experiences may help/hurt.

Thanks so much for getting back to me! Yeah there are several off cycle spots that I’ve applied to, I’ve followed up just waiting to hear back after their review process.

That said, I’m definitely not a traditional application (experiences that have led me to switch from anesthesia to rads – I’d like to email/ message you privately to get your take on this if possible). I’m okay with a gap year if in case I can’t get a spot off cycle and end up matching through the match cycle. It won’t be ideal but likely I’d be able to stay home with my baby in the interim.

Hi Ben, Thank you so much for your post. It was extremely helpful. I am an IMG who had finished a 4 year Radiology residency in my home country. I am taking my step 1 next month. I moved here earlier in the year after I got married. My question is, do I need to repeat the residency here? I have been told by various people that I can take the Alternative pathway and go right into fellowships and be board eligible with ABR. Is that true? Will this affect me later on for jobs? Also, how easy/difficult is it to get a radiology fellowship? Do you still need to be “matched” for fellowships? Any help you can provide will be appreciated. Thanks!

Yes, you are probably eligible for the Alternate Pathway, where instead of repeating a four year residency, you do four fellowships in a row at a single institution. This process is outside of the ACGME, and you don’t enter the match. The institution basically takes you on for the whole set at the outset. It works out well for people, the training is likely more at your level, but you don’t save a ton of time per se. You’ll be technically “more qualified” than US grads right out of fellowship as well. See this ABR page.

Hey Ben, Thanks for all the helpful info!! I’m a 32 year old 3rd year DO student on the east coast and am very interested in ACGME Radiology. I was a physician assistant in neurology for 4 years before I decided to make the switch. I got a 251 on step 1 (97% percentile comlex 1) and i’m in the top 10% of my class. I have a couple of research experiences, but not much. Looking at previous matches I feel I am aware of the chances a DO has in ACGME radiology, but I think I’m more concerned about my age. Do you think this will be a problem? How much? Thank you!

Hey Ben, Thanks for the informative post. Just started 3rd year at USC and very interested in rads. Like most others worrying about competitiveness I am worried my low step 1 (218) will hinder my chances in rads. I plan on taking step 2 earlier to help increase my chances and hopefully will at least high pass all of my rotations. How broad is broad/ how many programs should I aim to apply for? My hopes are to stay in California but I do not know if it is realistic. What do you think?

You’ll find a job no problem. How broad will depend on how third year goes in part as well as your complete application etc, but coming from California will help. For some reason, programs like the idea luring someone away from California. It’s not necessarily the total number (40?) but also the composition/competitiveness spread. It’s a good time to be a US allopathic applicant.

As for staying in Cali, I’d ask for a meeting with the PD at your school. For one, they’ll know how people have fared coming from your school, know the regional programs well, and will have the best-tailored advice to your situation. The other reason to do this is because a person’s best bet to get into a reach program is often their home institution. You want them to know who you are, like you, and maybe get you involved in some light research.

Thanks for the fast reply! Your advice is definitely comforting and I will definitely seek out a meeting with the PD. As for competitive spread, I’m not dying for a top ranked academic program and will definitely be more than happy at community programs. Simply put, I just want a career in radiology. Given that I am not the most competitive on paper (very light on research, low step 1) I just wanted to see if there was even an opportunity for me given the competitiveness of the field in general. I certainly hope my current location and medical school will help me get my foot in the door to a safe amount of programs, given that I am able to succeed on step 2 and in third year. Which rotations should I plan to get letters from/which will be the most relevant?

Medicine and surgery are usually considered the most predictive of general residency success. The radiology PD at your school can probably provide one, but having the others be from med/surg would be best. That said, if you have a chance to get a great letter from peds or ob/gyn, then go for it. A great clinical letter that illustrates how great, pleasant, and hardworking you are is the goal.

Hi Ben, Thanks for all your advice on this blog. Sounds like you’re well on your way through radiology residency and still helping students to this day. Questions about Step 2 ck scores: From your experiences, how much does Step 2 weigh into ranking applicants? I’ve heard that it really only matters if you score significantly above your step 1 score (i.e. > 15-20 points). What about scores below or at about the same as step 1? Also, do you know if programs generally want to see scores before ranking (i.e. is UCSF the only exception here) or can I hold off on releasing the score until after match?

In radiology not very much. The residencies that tend to have firm rules about Step 2 release/ranking tend to be for fields with lower board scores where people may actually end up failing Step 2 and potentially have start-time issues. I don’t think it’s common in radiology unless things have changed a lot nationwide over the past few years.

A Step 2 way above is nice. A Step 2 equally high or slightly higher than a high score is also nice—shows it wasn’t a fluke. Being around or slightly below Step 1 is usually judged as concordant, and basically no one cares.

Some programs (in general) give points in a grading schema for a good Step 1 and Step 2; if you don’t have a Step 2 to grade, then you wouldn’t get the points for it. Presumably not a dealbreaker in most cases.

Hey Ben awesome posts! Just had a question, I already applied to this years match specifically for IM categorical positions only, I was wondering if it’s too late to have a change of heart to go into radiology. I guess I’m wondering if I could apply to radiology after my intern year at a categorical program? Or if there are any other options you are aware of please let me know.

For a variety of reasons, some programs may have a PGY2 (R1) spot open up. These often are posted on forums like Aunt Minnie. You can apply to these outside of the match and thus not lose a year waiting, which is ideal. People do this every year. In fact, one of my friends from medical school made the switch a few months into his intern year into a different local program.

You can also always apply to radiology again in the match next year while you’re an intern. Travel for interviews can be difficult. Because radiology is an “advanced” field, basically any program you apply to in ERAS will require you to take a year off in some fashion. You could spend that time doing research, potentially moonlighting, etc, which may or may not jive with your personal goals.

It’s common for people in your shoes to apply through the match initially while also hoping to move laterally into an available PGY2 slot. Once you get a job, you then exit the match.

Hi Ben, I am a 4th year radiology us_img resident in my home country and planning to apply diagnostic radiology residency in US this year. My radiology program is the top university program here. Step 1 247. Step 2 252. I want to apply university programs. Should i apply community programs to be safe? My chance of matching into a good university program?

I’ve being following your posts for a while and you’ve been doing a really awesome job here. I was hoping you could help me with this, cause I am totally lost.

I’m an IMG graduated for 1 year and a half. I studied in one of the best medical schools in Brazil and was one of the best students in my class. Due to multiple factors, I had some money issues during my prep for the steps. Thus I could not afford to take the courses IMGs usually take or to do externships/observerships during med school. And I didn’t want to save money for another year and get a one more year of a gap in my curriculum. I took the steps and unfortunately got 222 on step 1 and 216(!!!) on CK. I’m devastated and I really regret not waiting one more year.

The thing is, my dream was Radiology. But with these scores, I think I won’t be able to enter any specialty. Therefore, I’m thinking about giving up.

Since you have a lot of experience with the process I wanted to know what your thoughts are.

Look at this document thoroughly. I agree radiology is probably a stretch unless you have an “in” or personal connection at a particular program. Your scores don’t disqualify you from training in the US in general though if that is your primary goal. If so, you could apply to rads as well as a less competitive field like FM. English fluency and visa status also play a role.

If radiology is most important to you, you could also finish radiology training in Brazil and then do the IMG alternative pathway (4 years of fellowship at a US institution). Most of the IMGs I know in radiology have actually done the latter, including 4 Brazilians at my institution. See https://www.theabr.org/ic-img-dr.

Hi Ben, Thanks for the great information here, it’s very encouraging to see the actual stats versus common perceptions about competitiveness for DR. I’m currently an MS3 and have no research experience in med school. That may change, but not sure how likely at this point. I do have research experience from graduate school working with CT data and creating 3D models of brain cases from various animals which lead to a poster presentation. Would this be relevant at all when applying?

First of all, thank you very much for all the info. I was hoping you’d have some advice for me. I’m a non-US (soon to be, in 2019) IMG from Ireland with a step 1 score in the mid-270’s, with basically no extracurricular activities or research experience at the moment. My question is, do I have a good chance at matching into top-tier programs and if not, what should I be aiming at? I was hoping to get 1 or 2 4-week observerships and at least a LoR from a radiologist (although considering that type of experience I’m not sure their input would have much value). Also, because of timing and circumstances, I may have to apply to ERAS the summer of grad year, so I’d be ending up with a gap year (in which I plan to at least sit the step 3) – would that significantly affect my chances?

That’s too unique a situation for me to have any specifics for you, but that depends on how narrowly you’re defining top tier. Either way, I’d pull no punches and apply broadly. I think you’ll have better luck overall at regional places of varying strengths but the process is idiosyncratic enough that you can never be sure. If you could land a US research year, nucs residency etc outside of the match for the gap year that would probably help. I don’t know what fraction of programs are screening out people who aren’t graduating in the year of application, I imagine overall that most are not screening that heavily these days and will still look at you.

Hi Ben, I want to thank you for all of your helpful advice! It’s been extremely helpful in getting me through my 3rd year of med school. I am halfway through my 3rd year, and I am pretty sure I am interested in radiology. I scored high 240s on step 1, but I have been having trouble honoring rotations 3rd year. I do well on the exams, but the subjectivity of 3rd year is not working in my favor, so I have honors in psych and HP for the rest. My school doesn’t give much advice regarding radiology, so I was wondering where I stand in terms of applying? I am currently working on a project with a radiologist at my school, but probably won’t get published. Thank you!

Hi Ben, Was reading your website and definitely could use advice. I’m a recent med graduate as of 2 weeks ago from a good US MD program. I’m without a prelim program or radiology residency after match and scramble. I have a good amount of research in Radiology (a few publications but also some projects that did not get published which was out of my control) and a lot of volunteer work for my school’s radiology department (creating radiology lectures for M1 and M2 students through the department, teaching students how to use ultrasound machines, some other work as well). The problem is my Step 1 score, which was ~200 (it was definitely a nightmare scenario, as I fell about 25 points below projection). Step 2 was ~235 but I did have to retake Step 2 CS (CIS portion, but passed on retake with flying colors 1 month later at a different location without changing anything on my approach to patient interaction, I can give more detail on that story if needed). Nice but not stellar clinical grades 3rd & 4th year. I had a decent amount of interviews when I first applied but things did not work out, my school’s PD was personally shocked at this result and was calling open programs on my behalf after the match.

Some people have been telling me to abandon Radiology, but I’m so passionate about this field that I’m too determined to just give up now. I want to reapply but I am not sure what the best route is. I’ve been considering a research year, but it’s been hard to find one for Radiology but I’ve been putting most of my time into finding a PGY-1 or TY year since the match. I plan on having a backup specialty (likely Neurology) just in case when I reapply to Radiology. Obviously, I have no problem with where I go to for residency, I’ll take any place that’ll have me. Any advice on what I should be doing and how I can make the most out of this?

Rads was really tight this last year. I would personally recommend that you concentrate on getting an internship. It’s quite possible some PGY2 slots will open up somewhere if somebody needs to change location, decides against rads, quits medicine, etc. You’d be competing for those slots with other folks, but you never know how many slots open up, how many candidates there are, or how flexible those people are willing to be. There’s no harm is making yourself available for a switch opportunity.

I think derailing your training and leaving clinical medicine before internship doesn’t seem like a strong bet as you suggested. I’d also argue that most places likely to consider you will have less of a research focus anyway, but that’s of course not a sure thing. You can apply in the match too during internship. If you match, then you’d potentially have a gap year to fill.

Hi Ben I am a non-US International Medical graduate, actually from a Caribbean School, done all my clerkships in the US, got all honors and one High Pass grade for my core rotations, deans medal for my basic sciences and have a few publications (both journal articles and conference presentations) in the primary care. I have pretty high score in Step 1 (>260) but with a low Step 2 Score (228), I am applying for RAD for this year’s match cycle. Can you please give me some suggestions on my chances to get interview calls (I have applied quite widely ~75 programs) and a match? I did apply for both categorical and advanced programs (at universities and community hospitals) with separate applications for preliminary year (PGY 1). I am bit worried about by unexpectedly lower score in my Step 2 and its impacts on my chances?

Hi Ben: Have a question, bit complicated one. I don’t really get how the matching works. I have this scenario, I like radiology as number one specialty and Internal medicine as second. So I applied for both radiology and IM programs at various places and getting interview calls now. I too applied for some prelim and TY programs as well thinking that advanced rad needs a prelim year. Now my questions are: 1. How do the ranking work? Do I have to rank both radiology and internal medicine in one list or two separate lists? 2. Will I have a situation that I matched an Advanced radiology program and not matched an internship year (say TY), then will my radiology match become invalid? 3. Whether in this situation how my IM ranking and match works?

In my brain, it works as follows, when I rank Rad as my preferable ranking, and if I matched one of them then whether the system automatically bypass my IM ranking and look for TY or internship match? And If I dont match internship year or TY then automatically my Rad match become invalid and the algorithm now look for IM rank and a match? Or by getting match for Advanced Rad program, will that institution provides an year of internship there itself?

I know it is bit complicated, a clear idea would be helpful for me to make a proper ranking after interviews..

You have a primary list that will include all advanced and categorical programs. You will also have a secondary prelim list, which is tied to only the advanced programs on your primary list. Check out the other fourth-year posts or the ebook for a longer description.

If you just don’t match to a prelim, you will SOAP for the prelim. You don’t lose your advanced spot. You also don’t automatically get a prelim for any advanced program; they’re separate.

Hi Ben I am in the middle of my interview season and I just found out that I failed my step 2CK. My step 1 score was 227 and I have 20 interviews. If I can take my CK and pass it, what are my chances of matching to radiology this cycle

Hi Ben Thanks for Awesome Post, I am a non-US International Medical graduate, I Love radiology, my usmle step score is 233 and now I coming for 1 year postdoc fellowship in Radiology department of Johns Hopkins, It is self funded, now I am offered a grant for two additional year in the lab. Beside trying to pass step 2 exams with High grade and publitining related articles, what else would you advise me to do during following years to increase my chance matching into radiology residency program? Thanks a lot Mohammadreza

what about students who have been dismissed from medical school but happen to continue their medical education at another carribean medical school, having learned from their mistakes have gotten 240 on step1 and 252 on step 2 , can they obtain a residency?